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DPD > Abdomen > Flashcards

Abdomen Flashcards

1
Q

What are the signs you are looking for in the hands?

A 
Asterixis 
Bruising  
Clubbing  
Dupuytren's Contracture  
Palmar Erythema  
Leuconychia 
Koilonychia
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2
Q

What are the signs you are looking for in the forearms?

A

AV fistulae

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3
Q

What are the signs you are looking for in the head and neck?

A

Anaemia
Jaundice
Skin: jaundice, scratch marks (excoriation marks) or spider naevi

Oral Examination:
Pigmentation
Gum hypertrophy

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4
Q

What are the signs you are looking for on the chest?

A

Gynaecomastia
Hair Loss
Excoriation Marks
Spider Naevi

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5
Q

Causes of hepatomegaly

A

Cancer (primary or secondary deposits)

Cirrhosis (later on in cirrhosis, the liver will shrink)

Cardiac:
Congestive cardiac failure
Constrictive pericarditis

Infiltration:
Fatty infiltration 
Haemochromatosis 
Amyloidosis 
Sarcoidosis
Lymphoproliferative disease
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6
Q

Summary of liver disease

A 
Alcohol  
Autoimmune  
Drugs  
Viruses  
Biliary Disease  
NOTE: these are the things to think about when you have any patient with jaundice, raised AST/ALT, raised BR
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7
Q

Causes of splenomegaly

A

Portal hypertension

Haematological:
E.g. haemolytic anaemia, lymphoma, leukaemia

Infection:
E.g. malaria, schistosomiasis, leishmaniasis, TB, infective endocarditis, infectious mononucleosis

Inflammation

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8
Q 
DDx of:
75 y/o man
Epigastric pain
HR: 130bpm
BP: 80/50mmHg
A

Ruptured AAA (pain radiating to back, tachycardiac, low BP)
Pancreatitis
Peptic Ulcer

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9
Q

What does constant abdominal pain usually indicate?

A

Inflammation

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10
Q

What does colicky abdominal pain usually indicate?

A

Obstruction

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11
Q

How does acute pancreatitis present? What is the main test to confirm?

A

Epigastric pain

HIGH amylase

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12
Q

How does chronic pancreatitis present? What is the main test to confirm?

A

Epigastric pain, weight loss
Loss of exocrine/endocrine function
NORMAL amylase
Faecal elastase (main test)

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13
Q

DDx of right upper quadrant pain

A

Gallbladder:
Gallstones
Cholecystitis
Cholangitis

Liver:
Hepatitis
Abscess

Above (Lungs)
Basal Pneumonia

Below (Appendix)
Appendicitis

Left (Stomach, Pancreas)
Peptic Ulcer Disease
Pancreatitis

Right (Kidney)
Pyelonephritis

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14
Q

DDx of right iliac fossa pain

A 
GI: 
APPENDICITIS 
Mesenteric adenitis  
Colitis (IBD) 
Malignancy

Gynaecological:
Ovarian cyst rupture, torsion or bleed
Ectopic pregnancy

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15
Q

DDx of suprapubic pain:

A

Cystitis

Urinary retention

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16
Q

DDx of left iliac fossa pain:

A

GI Causes:
DIVERTICULITIS
Colitis (IBD)
Malignancy

Gynaecological:
Ovarian cyst rupture, torsion, bleed
Ectopic pregnancy

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17
Q

DDx of diffuse abdominal pain

A

Obstruction

Infection:
Peritonitis
Gastroenteritis

Inflammation:
IBD

Ischaemia:
Mesenteric Ischaemia

Medical Causes: 
DKA 
Addison's Disease 
Hypercalcaemia 
Porphyria 
Lead poisoning
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18
Q

Which organs does the coeliac artery supply?

A 
Stomach
Spleen
Liver
Gallbladder
Duodenum
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19
Q

Which organs does the superior mesenteric artery supply?

A

Small intestine

Right colon

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20
Q

Which organs does the inferior mesenteric artery supply?

A

Left colon

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21
Q 
65 y/o man
AAA repair 2 days ago
Diffuse abdominal pain
HR: 120bpm
RR: 30

What will the blood test likely show?

A

Any cause of acute abdomen causes HIGH AMYLASE

Unlikely to have a normal amylase because he is tachycardic and tachypnoeic- indicates poor tissue perfusion and therefore some lactic acidosis

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22
Q 
55 y/o man
Excess ETOH use
Cirrhosis
Abdominal pain
Abdominal distension

O/E: Ascites, liver flap

How many neutrophils are you likely to see in spontaneous bacterial peritonitis?

A

Ascites neutrophils > 250 cells/mm3

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23
Q

Decompensated features of liver disease

A

Jaundice
Encephalopathy
Ascites

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24
Q

Causes of abdominal distension

A 
Fluid
Flatus
Fat
Faeces
Foetus
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25
Q

Signs of ascites

A

Shifting dullness

Features of liver disease

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26
Q

Signs of obstruction

A 
Nausea, vomiting
Not opened bowel
High pitched tinkling bowel sounds
?Previous surgery
?Tender irreducible femoral hernia in the groin
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27
Q

Causes of transudate in ascites

A

Cirrhosis
Cardiac failure
Nephrotic syndrome

28
Q

Causes of exudate in ascites

A

Malignancy
Infection (TB, pyogenic)
Budd-Chiari syndrome

29
Q

Causes of ascites with albumin gradient <11 g/L

A 
Nephrotic Syndrome 
Tuberculosis 
Pancreatitis (acute and chronic)
Cancer 
Peritonitis
30
Q

Causes of ascites with albumin gradient >11 g/L

A

CARDIAC FAILURE (acute and chronic)
CIRRHOSIS
Portal Hypertension
Constrictive Pericarditis

(high albumin gradient, likely due to chronic liver disease)

31
Q

Cause of pale stools

A

Low stercobilinogen

32
Q

Pre-hepatic causes of jaundice

A

Haemolysis, defective conjugation

33
Q

Hepatic causes of jaundice

A

Hepatitis

34
Q

Post-hepatic causes of jaundice

A

CBD obstruction
Stricture
Cancer of the head of the pancreas

35
Q

Causes of unconjugated hyperbilirubinaemia

A

Haemolysis

Gilbert’s syndrome

36
Q

What is hepatocellular jaundice?

A

Damage to liver cells, leakage of conjugated bilirubin from hepatocytes
This is soluble and secreted in urine, giving dark urine

37
Q

Causes of hepatitis

A

Alcohol
Autoimmune
Drugs
Viruses

38
Q

Difference in presentation with hepatitis vs obstruction

A

Both have dark urine

Obstruction also causes pale stools as no bilirubin reaches colon to be converted to stercobilinogen

39
Q 
DDx of:
Painless jaundice
Wt loss
Dark urine
Pale stool
A

Cancer of head of the pancreas

40
Q

What markers rise in post-hepatic jaundice?

A

ALP

GGT

41
Q

Which tumour marker is best associated with pancreatic cancer?

A

CA19-9

42
Q

What is Trousseau Sign of Malignancy?

A

Episodes of vessel inflammation due to a blood clot which are recurrent or appearing in different locations over time
Can be early sign of gastric cancer or pancreatic cancer

43
Q

Main causes of bloody diarrhoea

A

Infection
Inflammation
Malignancy

44
Q

Causes of infection in bloody diarrhoea

A 
Campylobacter
Haemorrhagic E. coli
Entamoeba histolytica 
Salmonella
Shigella
45
Q

Which group of people is inflammatory colitis more common in?

A

Young people with extra-GI manifestations

46
Q

Which group of people is ischaemic colitis more common in?

A

Elderly

47
Q

What are the extra-GI manifestations of inflammatory bowel disease?

A

Eyes: episcleritis, scleritis, uveitis
Skin: erythema nodosum, pyoderma gangrenosum

48
Q

What is the lead pipe sign?

A

Seen on AXR
Feature of inflammatory bowel disease
Loss of haustral markings of colon

49
Q

How does toxic megacolon appear on an AXR?

A

Colon diameter >6cm

50
Q

Management of Acute GI bleed

A 
ABC
IV access
Fluids
Group and Save, cross-match blood
OGD (find cause of bleed)
Antibiotics (e.g. tazocin, ciprofloxacin) and terlipressin (causes splanchnic vasoconstriction) in addition for variceal bleeds
51
Q

Management of Acute Abdomen

A 
NBM
Fluids
Analgesic
Anti-emetics
Antibiotics
Monitor vitals and urine output
52
Q

Investigations for acute abdomen

A

FBC- look at WCC (if it is infective)
U&Es- renal function and hydration status
CRP- marker of infection and inflammation
Clotting- to see if patient prone to bleeding in surgery
Erect CXR- look for air under diaphragm

53
Q

Investigations if patient presents with jaundice

A

FBC- check for various cause of jaundice
LFTs- important if liver pathology suspected
Abdominal USS- do after a fast, look for gallstones in distended, bile-filled gall bladder. Dilation of ducts shows some kind of obstruction

54
Q

Investigations if patient presents with dysphagia and wt loss

A

OGD and biopsy

55
Q

Investigations if patient presents with PR bleed and wt loss

A

Colonoscopy

56
Q

What is Pabrinex?

A

Injection of water-soluble vitamins
Given to patients with chronic liver disease
Contains thiamine, prevents Wernicke’s encephalopathy

57
Q

Management plan for patient with ascites

A 
Tap ascites, find WCC (to look for SBP)
If infective -> antibiotics
Diuretics to remove fluid
Dietary sodium restriction
Fluid restriction in patients with hyponatraemia
Monitor weight daily
Therapeutic paracentesis
58
Q

Management of patient with encephalopathy

A 
Lactulose- osmotic laxative
Phosphate enemas
Avoid sedation
Treat infections
Exclude GI bleed- alcoholic patients with chronic liver disease will have low urea, if it rises it could be due to digestion of blood cells
59
Q

What are the features of an anastamotic leak?

A

Diffuse abdominal tenderness
Guarding, rigidity
Hypotensive/tachycardic

60
Q

Features of a pelvic abscess

A

Pain, fever, sweats, mucus diarrhoea

61
Q

Presentation and treatment of perianal abscess

A

Tender, red swelling

Incision and drainage

62
Q

Presentation and treatment of anal fissures

A

Rectal pain
Stool coated with blood
Advice regarding diet (fluid, fibre)

GTN cream

63
Q

Presentation of irritable bowel syndrome

A

Recurrent abdominal pain, bloating
Improves with defecation
Change in frequency/form of stool (can be diarrhoea or constipation)

No PR bleed, anaemia, wt loss or nocturnal symptoms

64
Q

Difference in presentation of irritable bowel syndrome and inflammatory bowel disease

A

IBS does not have nocturnal symptoms, IBD does

65
Q

How to exclude coeliac disease

A

Measure tissue transglutaminase

66
Q

Treatment of IBS

A

Diet and lifestyle modification

Symptomatic treatment:
Abdominal pain- antispasmodics
Laxatives for constipation
Anti-diarrhoeals

DPD (3 decks)

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